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<br />PERMIT APPLICATION
<br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER I DEMOLITION
<br />CITY OF EVERETT PERMIT SERVICES
<br />3200 CEDAR STREET, EVERETT, WA 98201
<br />(P) 4'L5-257-8810 i FAX 425-257-8857 �(F) everetteps cr everettwa.gov � www•everettwa.yovipermits
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<br />�F2QJECT SITE AI3pR�S5 '� () `, + � �,� ' {�� Pf�tJPFRiY TAX #. � : L ' '' i� 7 �
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<br />_EGAL for new construc[ion Short Rf�dl;ut}divi ip��, �h �°Py 9 g p n�
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<br />DWNER NAME: i��' �� t(�.� I' pf�� ��� f,�/�'�� TENANT NAME (if GUmmerr.ial): i.,� �.�•
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<br />OWNER MAILING ADDRESS' c.1 vG�T `�f tJ + f � J��t �`'�l�z`'�
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<br />CON7RAGTC7R NAME: W�",S /�} ! ( % ' , (�.:ltta� ,�' ,/� i t.' ; ' � (r;' C C , _..r _.
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<br />CONTRACTOR ADDRESS: 7=-�- �"' �� � { ��� ` � �� L� -
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<br />CpNTRAGT�C3f3 UCENSE #{REQUIRED): �;�� "�^, "� � � {> �",��" ?_�. I'l' ��� CITY OF EVERETT BUSINESS I.IC�N3� #t{R�iatliFt�R) �`? �"7 � `��
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<br />PRIMARY CONTACT: ❑ OWNER ��t�f"�NTRACTOR ❑ OTHER (Piease Specify) �_ �- -
<br />CON'f'/�G'C N�ME: �.� °t _ . �
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<br />•: Contract Price of Work: S______ ------
<br />�x�sting Use of Builtiir�c�: `�"���
<br />Prr7posr:.d Use of k3uilcliny. Heat Source: OGas ❑Electric ❑Other�,,._._
<br />[3uilciinc� T�a: ❑SFR-Detached ❑SFR-Attached ❑C3uplex ❑Multi-�=amily-# of Units:__ ,,. � ❑Commercial ❑Indusirial
<br />�1�yE�t;. of I�rcaje�cl�. ❑New ❑Addltion ❑Remod�:i Cl}�e�z�ir ❑T.i. ❑Sign C1Sprinkler ❑Demolitlon ❑C#�ang+� of Use
<br />DESCRIPTION OF WORK. ,'� � _ � 1 � � ,- •• ° � �"
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<br />ASSOCIATED BUILDING PERMIT # (If rip��llc�i.�lE�1�.
<br />ACft�ti .��VL1.0 ( f��lEf1T / h,+v�a re✓«aiae�d tl�is ��rl ii,.,,�i�„� �ir,d ccniinn he �rdortnta 'on cnfcauicJ hnie�n a tr�i�- �+'�d r.-�rr,�r.l Work dor.e p.rt ���rt tn roti pr.nnu rrusi .:�, ,�,�y w���
<br />r,unent /r u�.r;,l ��:;'a:o �ind lor.r.d l.iw 17.^ yran�i�iy of .� permit :>nly auth�:�nro� apAroved w�,k ��nd no Ot;n.+li:�ns lherc bom Devia�innti rnu f Irrs! Lc a.di��o ized in v+,Lnry (r;m ll�e
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